Longer Visit Interval OK in Stable HIV

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

A retrospective study found that HIV-infected patients with undetectable viral loads were not more likely to have virologic failure if seen at 4- or 6-month intervals, compared with patients seen at guideline-recommended 3-month intervals.

Note that CD4 count <200 cells/mm3 and cancelling an appointment were risk factors for virologic failure.

SAN DIEGO – Going 4 or 6 months between office visits instead of the standard 3 does not appear to compromise virologic control among stable HIV-infected patients, researchers suggested here.

After 12 months, 75% of the HIV patients who saw their doctors on a 3-month interval maintained virologic control, said April Buscher, MD, an attending physician at Durham VA Medical Center in North Carolina.

If patients only saw their physicians every 4 months, 75% still had undetectable viral loads at the end of a year. If the patients only saw their doctors twice a year – every 6 months -- at the end of 12 months 76% had maintained virologic control, Buscher reported at her poster presentation at IDWeek.

"Our data show that participants who were scheduled a next HIV primary care clinic visit in 4 months or in 6 months were not at increased risk of virologic failure at 12 months compared with persons with a follow-up scheduled at 3 months," she told MedPage Today.

She said that reduced office visits mean lower costs for patients, less time dealing with their illness, and less disruption of regular activities – without a loss of virologic control.

Buscher performed the study while a resident at Baylor College of Medicine in Houston, and covered six different clinic sites. She and her colleagues performed a retrospective cohort study of HIV-infected persons, eventually identifying 1,512 men and 653 women for the study.

The participants averaged about 47 years old; 21% were white, 58% were black and 22% were Hispanic. All the patients had an undetectable viral load at baseline, and then were assessed 12 months later.

"A three-month interval for the office visit and for testing is the standard of care for patients with HIV infection," Buscher said.

In her study, 1,429 patients were seen every 3 months. Another 574 patients had office visits scheduled every 4 months, and 168 patients had office visits scheduled every 6 months. She suggested that the small number of patients with 6-month visits might limit the generalizability of her findings for that group.

In their analysis, Buscher and colleagues observed that patients who missed or cancelled visits or had CD4-positive cells counts below 200 cells/mm3 were more likely to experience virologic failure – detectable HIV in the blood using the 400 copies/ml assay.

"This is one of the first studies that has looked at outcomes among patients who canceled appointments," Buscher said. She found that 71% of patients who canceled an appointment maintained virologic control at 1 year, compared with 81% of patients who kept their appointments (P<0.01). Similarly, just 58% of patients who missed appointments maintained virologic control after a year (P<0.01).

She suggested that seeing patients less often than every 6 months might make it more problematic dealing with other comorbidities that occur in aging populations – including heart disease, hypertension, and obesity -- so that yearly visits, for example, might not be beneficial.

Meghan Rothenberger, MD, assistant professor of medicine at the University of Minnesota, Minneapolis, told MedPage Today, "In my HIV clinic I have patients that I am very comfortable in seeing every 6 months."

But Rothenberger added that there are others for whom -- for reasons unrelated to HIV -- there is concern about adherence. "So there are some patients who I want to see more often and every 3 months is a good interval for them." Rothenberger did not participate in Buscher's study.